Epidemiological characteristics and organisation of care for patients with diabetic foot syndrome in Khanty-Mansiysk autonomous okrug–Yugra

Background. Epidemiological studies in regions of Russia have revealed significant differences in the prevalence of diabetic foot syndrome (DFS). Aims. To determine the epidemiological characteristics and associated complications of DFS in Khanty-Mansi Autonomous Okrug (KHMAO)-Yugra Materials and methods.The epidemiological indicators and complications of diabetes were determined in diabetic patients in KHMAO-Yugra. The statistical reporting form №12 was used. Data from patients diagnosed with type 1 or type 2 diabetes and DFS were gathered from the service area of hospitals, the state registry (20072014) and outpatient clinics in the city of Surgut (20092014). A prospective observational study with active screening and characterisation of DFS was conducted. Results.Of all patients, 43% were at high/very high risk of developing DFS. DFS was diagnosed in 4.1% of patients with diabetes and was characterised as neuropathic (57.3%), neuroischaemic (35.1%) and ischaemic (7.6%). Conclusions.Prevention and early diagnosis of DFS is crucial in the prevention and reduction of amputations in patients with diabetes. Given that DFS can present in various forms, programmes aimed at promoting DFS awareness are required to increase the identification and treatment of this syndrome. Additionally, improvements in the statistical tests used and better organisation of the flow patients referred to general physicians, endocrinologists, podiatrists and surgeons, are also important in the prevention and early diagnosis of DFS and its associated complications.

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The problem of classification and organization of medical care for diabetic patients with different forms of ulcerative-necrotic lesions of lower extremities

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2016-94-8-623-627 ◽

2016 ◽

Vol 94 (8) ◽

pp. 623-627

Author(s):

Oleg V. Udovichenko

Keyword(s):

Diabetic Foot ◽

Venous Insufficiency ◽

Main Group ◽

Diabetic Foot Syndrome ◽

Diabetic Patients ◽

Epidemiological Surveys ◽

Patients With Diabetes ◽

Post Traumatic ◽

High Level

Patients with diabetes mellitus (DM) are at risk of development of both diabetic foot syndrome and ulcers on the lower legs due to chronic venous insufficiency and other factors. The main group in this study was comprised of diabetic patients with ulcers of different etiology (venous, post-traumatic, mixed) treated at the Diabetic Foot Cabinet during 5 years (n=101). The group of comparison included simultaneously treated patients with diabetic foot syndrome (n=721). Patients of the main group was dominated by women (71%) and patients with type 2 DM. Ulcer healingdue to the treatment, persistent non-healing ulcers, and high-level amputations occurred equally often in the two groups: 60 and 58%, 18 and 15%, 4 and 5% respectively (р>0,05). Lower leg ulcers in DM are very persistent and constitute a serious medico-social problem to be addresses based at Diabetic Foot cabinets. The frequency of such ulcers and related amputations must be taken into consideration in epidemiological surveys.

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Screening Strategy of Pancreatic Cancer in Patients with Diabetes Mellitus

Diagnostics ◽

10.3390/diagnostics10080572 ◽

2020 ◽

Vol 10 (8) ◽

pp. 572

Author(s):

Suguru Mizuno ◽

Yousuke Nakai ◽

Kazunaga Ishigaki ◽

Kei Saito ◽

Hiroki Oyama ◽

...

Keyword(s):

Diabetes Mellitus ◽

Pancreatic Cancer ◽

Epidemiological Studies ◽

Screening Strategy ◽

Diabetic Patients ◽

Reverse Causality ◽

Pilot Studies ◽

Patients With Diabetes ◽

High Risk Populations ◽

New Onset

The incidence of pancreatic cancer (PCa) is increasing worldwide and has become one of the leading causes of cancer-related death. Screening for high risk populations is fundamental to overcome this intractable malignancy. Diabetes mellitus (DM) is classically known as a risk factor for PCa. Recently the reverse causality is in the spotlight, that is to say, DM is considered to be a manifestation of PCa. Numbers of epidemiological studies clarified that new-onset DM (≤2-year duration) was predominant in PCa patients and the relative risk for PCa inversely correlated with duration of DM. Among patients with new-onset DM, elder onset, weight loss, and rapid exacerbation of glycemic control were reported to be promising risk factors and signs, and the model was developed by combining these factors. Several pilot studies disclosed the possible utility of biomarkers to discriminate PCa-associated DM from type 2 DM. However, there is no reliable biomarkers to be used in the practice. We previously reported the application of a multivariate index for PCa based on the profile of plasma free amino acids (PFAAs) among diabetic patients. We are further investigating on the PFAA profile of PCa-associated DM, and it can be useful for developing the novel biomarker in the near future.

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Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome—A Review

Angiology ◽

10.1177/00033197211042684 ◽

2021 ◽

pp. 000331972110426

Author(s):

Martyna Schönborn ◽

Patrycja Łączak ◽

Paweł Pasieka ◽

Sebastian Borys ◽

Anna Płotek ◽

...

Keyword(s):

Diabetic Foot ◽

Healing Process ◽

Arterial Disease ◽

Angiogenic Factors ◽

Diabetic Foot Syndrome ◽

Tissue Loss ◽

Comprehensive Treatment ◽

Diabetic Patients ◽

Impaired Wound Healing ◽

Peripheral Arterial

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

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Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

10.21203/rs.2.16549/v3 ◽

2020 ◽

Author(s):

Olufunmilayo O Adeleye ◽

Ejiofor T Ugwu ◽

Ibrahim D Gezawa ◽

Innocent Okpe ◽

Ignatius Ezeani ◽

...

Keyword(s):

Renal Impairment ◽

Hospital Mortality ◽

Cardiac Failure ◽

Diabetic Foot ◽

Foot Ulcers ◽

Diabetic Patients ◽

High Morbidity ◽

Diabetic Foot Ulcers ◽

Grade 3

Abstract Background: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study was undertaken to determine factors that predict mortality in patients hospitalized for DFU in Nigeria.Methods:The current study was part of Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented to participate were recruited and subjected to relevant clinical, biochemical and radiological assessments and multidisciplinary care until discharge or death. Data for type 1 diabetes mellitus (DM) patients were expunged from current mortality analysis due to their small number.Results: Three hundred and twenty three type 2 DM subjects with mean age and mean duration of DM of 57.2 11.4 years and 8.7± 5.8 years respectively participated in this study. The median duration of ulcers was 39 days with a range of 28 to 54 days and majority (79.9%) presented with advanced ulcers of at least Wagner grade 3. Mortality of 21.4% was recorded in the study, with the highest mortality observed among subjects with Wagner grade 5. Variables significantly associated with mortality with their respective p values were DM duration more than 120 months (p 0.005), ulcer duration > one month (p 0.020), ulcer severity of Wagner grade 3 and above (p 0.001), peripheral arterial disease (p 0.005), proteinuria (p <0.001), positive blood cultures (p<0.001), low HDL (p <0.001), shock at presentation (p<0.001), cardiac failure (p 0.027),and renal impairment (p <0.001). On Multivariate regression analysis, presence of bacteraemia (OR 5.053; 95% CI 2.572-9.428) and renal impairment (OR 2.838; 95% CI 1.349 – 5.971) were significantly predictive of mortality independent of other variables.Conclusions: This study showed high intra-hospital mortality among patients with DFU, with majority of deaths occurring among those with advanced ulcers, bacteremia, cardiac failure and renal impairment. Prompt attention to these factors might be helpful in improving survival from DFU in Nigeria.

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ECG Body Surface Mapping Changes in Type 1 Diabetic Patients with and without Autonomic Neuropathy

Physiological Research ◽

10.33549/physiolres.931715 ◽

2010 ◽

pp. 203-209

Author(s):

S Palová ◽

K Szabo ◽

J Charvát ◽

J Slavíček ◽

E Medová ◽

...

Keyword(s):

Autonomic Neuropathy ◽

Body Surface ◽

Diagnostic System ◽

Diabetes Mellitus Type 1 ◽

Diabetic Patients ◽

Body Surface Mapping ◽

Surface Mapping ◽

Patients With Diabetes ◽

Type 1 Diabetic Patients

ECG body surface mapping (BSM) parameters in patients with diabetes mellitus Type 1 (DM1) are significantly different comparing to healthy non-diabetic subjects. Hypothesis that these changes are more pronounced in DM1 patients with autonomic neuropathy (AN) was tested. The parameters of BSM were registered by diagnostic system Cardiag 112.2 in 54 DM1 patients including 25 with AN and 30 control subjects. AN was diagnosed according to Ewing criteria when two or more Ewing tests were abnormal. In classic 12-lead ECG the heart rate was increased, QRS and QT shortened (p<0.01) and QTC prolonged in DM1 patients. The VCG measurement of QRS-STT angles and spatial QRS-STT angle showed non-significant differences. The absolute values of maximum and minimum in depolarization and repolarization isopotential, isointegral, isoarea maps were significantly different in DM1 patients in comparison with controls (p<0.01). The changes were more pronounced in DM1 patients with AN than in DM patients without AN (p<0.05). The QT duration measured in 82 leads of thorax was significantly shortened in 68 leads of both groups of DM 1 patients (p<0.01) when compared with controls. In 34 of them this shortening was more pronounced in DM1 patients with AN than in DM1 patients without AN (p<0.05). The results showed that the method of ECG BSM is capable to confirm the presence of autonomic neuropathy in diabetic patients.

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Volume rendered 3D OCTA assessment of macular ischemia in patients with type 1 diabetes and without diabetic retinopathy

Scientific Reports ◽

10.1038/s41598-021-99297-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Enrico Borrelli ◽

Domenico Grosso ◽

Mariacristina Parravano ◽

Eliana Costanzo ◽

Maria Brambati ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Healthy Subjects ◽

Diabetic Group ◽

Control Group ◽

Diabetic Patients ◽

Vascular Volume ◽

Patients With Diabetes ◽

Perfusion Density

AbstractThe aim of this study was to measure macular perfusion in patients with type 1 diabetes and no signs of diabetic retinopathy (DR) using volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA). We collected data from 35 patients with diabetes and no DR who had OCTA obtained. An additional control group of 35 eyes from 35 healthy subjects was included for comparison. OCTA volume data were processed with a previously presented algorithm in order to obtain the 3D vascular volume and 3D perfusion density. In order to weigh the contribution of different plexuses’ impairment to volume rendered vascular perfusion, OCTA en face images were binarized in order to obtain two-dimensional (2D) perfusion density metrics. Mean ± SD age was 27.2 ± 10.2 years [range 19–64 years] in the diabetic group and 31.0 ± 11.4 years [range 19–61 years] in the control group (p = 0.145). The 3D vascular volume was 0.27 ± 0.05 mm3 in the diabetic group and 0.29 ± 0.04 mm3 in the control group (p = 0.020). The 3D perfusion density was 9.3 ± 1.6% and 10.3 ± 1.6% in diabetic patients and controls, respectively (p = 0.005). Using a 2D visualization, the perfusion density was lower in diabetic patients, but only at the deep vascular complex (DVC) level (38.9 ± 3.7% in diabetes and 41.0 ± 3.1% in controls, p = 0.001), while no differences were detected at the superficial capillary plexus (SCP) level (34.4 ± 3.1% and 34.3 ± 3.8% in the diabetic and healthy subjects, respectively, p = 0.899). In conclusion, eyes without signs of DR of patients with diabetes have a reduced volume rendered macular perfusion compared to control healthy eyes.

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Possibilities of combined surgical treatment of pyonecrotic lesions in the neuroischemic form of diabetic foot syndrome

Diabetes Mellitus ◽

10.14341/2072-0351-5412 ◽

2009 ◽

Vol 12 (1) ◽

pp. 8-13

Author(s):

Valeriy Afanas'evich Mitish ◽

I A Eroshkin ◽

Gagik Radikovich Galstyan ◽

Lyudmila Petrovna Doronina ◽

Yu S Paskhalova ◽

...

Keyword(s):

Surgical Treatment ◽

Diabetic Foot ◽

Lower Extremities ◽

Lower Leg ◽

Diabetic Foot Syndrome ◽

Diagnostic Tools ◽

Critical Ischemia ◽

Adequate Treatment ◽

Patients With Diabetes ◽

Foot Lesions

Aim. To present results of combined surgical treatment of the ischemic form of diabetic foot syndrome complicated by pyonecrotic process. To show thatthe use of modern diagnostic tools and the choice of adequate treatment strategy permits to substantially reduce the number of above-the-knee amputations. Materials and methods. A total of 140 patients with diabetes mellitus and critical ischemia of lower extremities were under observation during 2004-2008.All of them had purulent and/or necrotic foot lesions. The patients were examined by X-ray, computed and magneto-resonance tomography of the feet,duplex scanning of lower leg vasculature, transcutaneous measurement of PO2, pelvic and lower leg arterial angiography. Results. A strategy of surgical treatment was developed to be used depending on the patients health status, clinical features and severity of pyonecroticprocesses in the foot, and the degree of involvement of the main blood vessels of lower extremities. Conclusion. Combination of endovascular surgery with various methods for plastic wound closure permits to extend the range of possibilities for the treatmentof high-risk patients, such as those with pyonecrotic lesions and neuroischemic form of diabetic foot syndrome. This approach opens up prospects fora significant decrease of percentage of above-the-knee amputations and improves the quality of life in these patients.

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Prevalence and phenotypic features of diabetes due to recessive, non-syndromic WFS1 mutations

Acta Endocrinologica ◽

10.1530/eje-21-0097 ◽

2021 ◽

Author(s):

Mingqiang Zhu ◽

Yangxi Li ◽

Guanping Dong ◽

Xuefeng Chen ◽

Ke Huang ◽

...

Keyword(s):

Pediatric Patients ◽

Wolfram Syndrome ◽

Diabetic Patients ◽

Insulin Deficiency ◽

Patients With Diabetes ◽

Mild Diabetes ◽

Similar Phenotype ◽

Systemic Disorder ◽

Phenotypic Features

Objective: Recessive WFS1 mutations are known to cause Wolfram syndrome, a very rare systemic disorder. However, they were also found in non-syndromic diabetes in Han Chinese misdiagnosed with type 1 diabetes, a molecular cause that appears to be considerably more common than the fully expressed syndrome. We aimed to better define the incidence and clinical features of non-syndromic diabetes due to recessive WFS1 mutation. Design: We analyzed the genotype and phenotype of 320 consecutive incident Chinese pediatric diabetic patients diagnosed from 2016 to 2019 to search for non-syndromic diabetic cases due to recessive WFS1 mutation. Methods: A cohort of 105 pancreatic autoantibody-negative patients were recruited for exome sequencing. All patients tested positive for pathogenic diallelic WFS1 mutations were examined for phenotypic features (fundoscopy, audiogram, urine density). Results: We found three cases of non-syndromic diabetes due to recessive WFS1 mutations (incidence = 0.94% (95CI 0.25%-2.7%)). All three cases only had mild diabetes when diagnosed. All patients had well conserved fasting C-peptide when diagnosed but one of them progressed to T1D-like insulin deficiency. In addition, we found a fourth case with previously undetected features of Wolfram syndrome. Conclusions: Non-syndromic diabetes due to WFS1 mutation may be common among Chinese pediatric patients with diabetes. It is important to differentiate it from other MODY subtypes with similar phenotype by molecular diagnosis because of different prognosis and, potentially, therapy.

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Methicillin-Resistant Staphylococcus aureus Diabetic Foot Crossed Infection: A Case Report

Pathogens ◽

10.3390/pathogens9070549 ◽

2020 ◽

Vol 9 (7) ◽

pp. 549 ◽

Cited By ~ 1

Author(s):

María Reina-Bueno ◽

Inmaculada C. Palomo-Toucedo ◽

Aurora Castro-Méndez ◽

Gabriel Domínguez-Maldonado ◽

María del Carmen Vázquez-Bautista

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Immunological Response ◽

Multidrug Resistant ◽

Healthcare Personnel ◽

Diabetic Patients ◽

Methicillin Resistant ◽

Specific Protocol ◽

Hygiene Measures ◽

Patients With Diabetes

This work presents a protocol to prevent the transmission of multidrug-resistant infections. We focus on the Diabetic Foot Unit Podiatry Clinic Area attached to the University of Seville in particular. The most common complication for patients with diabetes is leg ulcers. Together with neuropathy, vasculopathy, and immunological response disorder, these individuals have a high predisposition to developing infections. Staphylococcus aureus is a highly prevalent microorganism in humans which, at times, may act as a pathogen. Due mainly to indiscriminate abuse of antibiotics, the methicillin-resistant strain known by its initials as MRSA is the most extended nosocomial infection globally and is a severe community and hospital healthcare problem. This paper describes compliance with new general recommendations on cleaning, hygiene, and decontamination, in addition to implementation of this specific protocol, after detection of cross infection (healthcare-related infection) in the studied unit in two patients with MRSA-infected ulcers. After an in-depth bibliographical review, strict hand hygiene measures and use of non-sterile gloves were used when treating all patients with a diabetic foot. Finally, we reflect on the need to educate healthcare personnel to guarantee correct prescription of selected antibiotics. The role of the podiatrist in the multidisciplinary team is highlighted not only in terms of management and treatment of lesions in diabetic patients, but also as a healthcare agent for the detection and prevention of MRSA together with other multidrug-resistant infections.

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